• Like
ECG: Atrial Infarct
Upcoming SlideShare
Loading in...5
×
Uploaded on

 

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
No Downloads

Views

Total Views
2,301
On Slideshare
0
From Embeds
0
Number of Embeds
1

Actions

Shares
Downloads
57
Comments
0
Likes
1

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. PHYSICIANS MEET PROF.DR.DHANDAPANI’S UNIT AN INTERESTING ECG DR D SUBBURAJ
  • 2.
    • 65/M presented with substernal chest discomfort , lasted for 15 mins
    • Not radiating
    • Ass. With nausea & diaphoresis
    • No h/o DM or SHT
    • o/e - diaphoretic, BP- 90/60mmHg, PR-54bpm
    • CVS- S1 S2 +, No murmur RS - NVBS + , Other systems- normal
  • 3.  
  • 4. LIMB LEADS
  • 5. Chest leads v1
  • 6. ECG FINDINGS
    • Sinus rhythm
    • Rate-54
    • PR-252ms
    • Cardiac axis 2 degrees
    • QTc-399 ms
    • ST elevation II,III,a VF,V5,V6. depression I,a VL,V2,V3
    • P Ta elevation II,III,a VF,V5 ,V6, depression in V1,V2
  • 7.
    • Pta SEGMENT ELEVATED IN II,III , aVF.
  • 8.
    • CHEST LEADS
  • 9.
    • ATRIAL INFARCT WITH INFERO POST LATERAL WALL INFARCT & FIRST DEGREE HEART BLOCK
  • 10. ATRIAL INFARCTION
    • Seen in upto 10% of patients with STEMI.
    • Rt atrial 81-98%
    • Biatrial 19-24%
    • Lt atrial 2-19%
    • Often clinically unrecognized because of its subtle ECG changes.
  • 11. DIAGNOSIS
    • The diagnosis of atrial infarction is usually made from elevation of P-Ta segment in the clinical setting of MI.
    • The diagnosis may be entertained when the P-Ta segment is minimally elevated, i.e. in the same direction as the p wave. (Schamroth)
  • 12. P-Ta segment
    • From end of P wave to beginning of QRS
  • 13. DIAGNOSTIC CRITERIA
    • 1. PTa segment elevation >0.5 mm in leads v5,v6 with reciprocal PTa segment depression in leads v1,v2.
    • 2. PTa segment elevation >0.5 mm in lead I with reciprocal PTa segment depression in leads II,III
  • 14.
    • PTa segment depression >1.5 mm in precordial leads .
    • PTa segment depression >1.2 mm inleads I,II,III and in associaton with any atrial arrhythmias.
    • 5 Abnormal p wave: flattening of p wave in M pattern, flattening of p wave in W pattern,
    • irregular or notched p wave according to lieu et al
  • 15. COMPLICATIONS
    • Arrhythmias :61-74%
    • AF, SVT, atrial premature beats
    • Thromboembolism: 84 %
    • systemic, pulmonary
    • Atrial rupture :4-5%
    • Hemodynamic disturbances
  • 16. RCA
    • RCA SUPPLIES SA node,AV node, RV , posteromedial papillary muscle ,inf part of LV, variabily post&lat segments of LV.
    • RV BRANCH –from proximal seg of RCA
    • RCA OCCLUSION-
    • SA NODE- sinus bradycardia
    • AVNODE-AV nodal block
    • RV-Cardiogenic shock
    • PAPILLARY MUSCLE-MR
    • INFERO POST LATERAL MI
  • 17. RCA OR CX ?
    • RCA
    • ST elevation III>II
    • ST depression aVL> I
    • ST dep in I
    • CX
    • ST elevation in II>III
    • ST isoelectric LEAD I
    avL aVR III II
  • 18. PROXY OR DISTAL
    • RV branch is from proxymal seg
    • PROXYMAL OCCULSION- ST ELEVATION & POSITIVE T in V 4R,
    • DISTAL- ISOELECTRIC ST,POSITIVE T.
    • NEGATIVE T- CX OCCULSION
    • ATRIAL INFARCT – PROXYMAL OCCLUSION
  • 19.
    • ANOTHER ECG OF RCA OCCLUSION
    I II III aVF aVL aVR V1 V2 V3 V4 V5 V6
  • 20.
    • REF : HURST 11 th edition
    • SCHAMROTH
    • THANK YOU